But an “elaborate lie” between the New York orphanage where she was placed in as a baby, her doctors and her adopted parents meant the truth was hidden from her for 40 years.

But after the city issued her with a new birth certificate, she is understood to be the first US citizen to be designated as “intersex” on the document, instead of male or female.

Speaking to Independent.ie Ms Keenan, who uses female pronouns, explained that her adoptive parents are Irish, with her father hailing from Castlerea in Co Roscommon.

She said: "Gender is in the brain, not between the legs, and everyone is entitled to an accurate gender descriptor so long as governments continue to collect unscientific data about sex based on the appearance of genitals at birth or altered genitals after birth.

Ms Keenan continued: "A huge amount of suffering is created in the world by forcing people to conform to the male/female binary gender classification system, which has been proven scientifically to be as valid as the 'flat earth theory'."

She explained that she got the historic birth certificate by first getting a court order in California declaring her gender to be "non-binary."

"Then I asked NY to honor that," she said. "They chose to create the third category "Intersex" which is a good first step.

"But they erroneously attach gender identity to known biology, which currently denies queer people who identify as neither male nor female, or both male and female, from being included.

Sara and husband David

"I hope that will change soon when non-intersex people in NY petition for changes to their birth certificates to Non-Binary."

Ms Keenan said she has been happily married to a man for almost 30 years. They live in an open and supportive community in California but Ms Keenan said there are many who live in parts of the US where she claims there will soon be a war on LGBTIQA+ community.

Although it is difficult to accurately measure, since intersex conditions are not always accurately diagnosed, some experts estimate that as many as one in every 1,500 babies are born with genitals that cannot be classified as male or female.

Despite being lied to about her gender identity for most of her life Ms Keenan, who now lives in California said she “always knew I wasn’t a normal female”.

She had grown to over six feet tall by the time she was 13. From 16, she knew she would not ever be able to have children and that she would need to take hormones for the rest of her life to prevent her bones from becoming brittle.

“I’ve always felt like I was intergender, even before I knew about it,” she said.

Around seven years ago, just before her Irish father died, she asked him about it.

“He told me that he had found out about it when I was a teenager," she said. "The decision was made not to give me all the information because they thought it would confuse me in life.

Despite this she now receives huge support from her adoptive family.

Ms Keenan said more needs to be done for intersex babies.

"They are still being surgically altered in America because society is uncomfortable with the appearance of their genitals.

"We are talking about genitals capable of sexual activity and capable of providing pleasure that will be replaced with scar tissue and the absence of the sensitive tissue that provides sexual gratification. No society or parent should have the right to consign a baby to a less pleasurable life trapped in a body altered forever without their consent.

"These surgeries, when strictly for cosmetic reasons and not for urological reasons, should wait until the owner of the genitals reaches an age to decide what gender is most true for them and whether or not they want their special, not wrong, genitals altered and are willing to risk the loss of sensation. "

She said she hopes intersex recognition will "slow the rush to use scalpels on babies' genitals".

"We don't necessarily need to be fixed. We are not a human weed, We are our own very special flower."